REFERRED PAIN INTO THE HIP AND THE THIGH
REFERRED PAIN FROM THE LOWER BACK
Pain into the the hip and thigh can often be associated with referred pain from the lower back and one of the most common reasons is because of trapped nerves. Sometimes this can also be due to joint pain from either the lower back or sacro-iliac joints. In this case the characteristics of the pain will often be different in nature. Joint pain in the lower back usually manifest itself as a sharper pain short-lived generated by movement that transfers to the buttock or upper thigh and sacra-iliac pain often refers to the upper buttock and groin.
Each vertebra in the spine has numbers as you can see in the diagram. In the lower back or “lumbar spine”, the vertebrae are numbered L1 to L5. Slipped, herniated or disc bulges or protrusions usually occur at the bottom your lower back at L3, L4 or L5 where nerves exit, and these are numbered S1-S5.
he discs at the bottom of your lower back (L3/L4, L4/L5 and L5/S1) are the levels most likely to suffer from trapped nerves because these areas help support most of the weight of your upper body (two thirds of your total body weight). The sciatic nerve runs from the bottom three vertebra as seen below and innervates the area around your hip, the back of the thigh and lower leg and foot.
If a nerve is trapped at L2 or L3 or L4 this will affect the femoral nerve ( as seen below) and we suffer from femoral nerve impingement which provides both feeling and power to the front of the thigh. Therefore we experience pain in this specific anatomy.
These conditions cause a characteristic pain distribution down the leg. The areas of skin a single nerve innervates in the leg is called a dermatome. Each specific nerve will be responsible for sensory perception in a very specific area of skin (sensory perception being temperature, touch, vibration, pressure and pain). Therefore if a nerve is impinged in the lower back, pain and pins and needles (or paraesthesia) will refer to any given dermatome. So sciatic pain will potentially refer to any of those areas innervated from L3 to S3 levels (these levels innervate the back of the leg) and femoral nerve impingement will cause pain L2-L4 levels (these dermatomes innervate the front of the thigh) which provide both feeling and power to the front of the thigh
Things to be aware of that are clinically significant and indicate that you need to take further action when you have sciatica are;
- Severe impingement can weakness in the ankle when walking (known as foot drop)
- Progressive leg weakness
- In extreme cases loss of bowel or bladder control and tingling/ numbness in groin area indicates a possible medical emergency.
For the femoral nerve. This nerve generally provides both feeling and power to the front of the thigh (it innervates what we call the hip flexors and knee extensors). Movements such as climbing stairs (the knee may unstable and prone to buckling) will be difficult as your thigh muscles will feel weak. Pain may also be felt on the side of the buttock, groin, inside of the knee and lower leg.
It is also worth mentioning that all the muscles in the legs are also innervated by nerves from different levels in the spine as well. These are called myotomes. The sciatic nerve for example will carry nerves for both sensory and motor innervation (motor as in ‘motor power’). The information you give us in clinic and our clinical testing will help establish at which level in your spine you have a trapped nerve.
Our new IDD Therapy programme is effective in treating trapped nerves, is non-invasive (unlike surgery) and is pain free. IDD Therapy bridges the gap between what manual therapy cannot achieve and surgery. This therapy is the fastest growing therapy for trapped nerves and degenerative disc issues in the UK.
HERNIATED & BULGING DISCS
There are a few terms commonly used when describing discs which we can quickly clarify.
A disc bulge is where the outer wall of the disc bulges out from its normal position. The disc wall is not broken, and the nucleus material is contained inside the disc. As the disc bulges, it may press against nerves directly. Often a bulge can be associated with a loss of disc height and this may lead to impingement of a nerve as it exits the spinal canal via a gap (called a foramen) between two vertebrae.
A herniated disc is the same as a prolapsed disc. This is where the nucleus of the disc breaks through the outer disc wall. There will be a loss of disc height as the disc loses pressure and the nucleus material can press directly on to the spinal nerves causing pain. Or, the material of the disc nucleus may act as a biochemical irritation to the nerve in which case the result is the same … pain!
A “slipped disc” is an everyday expression which doesn’t have a true medical definition. It can imply a disc bulge or a herniation, usually a herniation.
This MRI below demonstrates a herniated disc pressing on nerves. The nerves are demonstrated by the broad white descending line seen in the scan. This is the spinal cord and departing spinal nerves. If you look carefully you can see the herniation making contact with these delicate structures.
The resulting pain from a herniated disc will often refer (hence the term radicular pain) down the pathway of a nerve and into the limb it innervates causing either sciatica (in the case of the lower back) or pain into the neck, shoulder and arm (if in the neck). This can often be accompanied with pins and needles in the foot or hand depending on this location.
“Our IDD Therapy programme can help treat trapped nerves, is non-invasive (unlike surgery) and is pain free. IDD Therapy bridges the gap between what manual therapy cannot achieve and surgery. This therapy is the fastest growing therapy for trapped nerves and degenerative disc issues in the UK.”
REFERRED PAIN FROM THE KNEE
Pain can also be generated from the kneecap (patella) and this can result in thigh pain. It is also important to remember that any instability or trauma to significant structures in the knee can also cause referred pain into the thigh as well. Examples would be ligament, muscle or meniscal injuries or osteoarthritis of knee joint or indeed any damage to the fibula in the lower leg.